University of Oulu

Sarjanoja, E., Klintrup, K., Ohtonen, P., & Kauppila, J. H. (2022). Annual hospital volume and colorectal cancer survival in a population-based nationwide cohort study in Finland. European Journal of Surgical Oncology, 48(7), 1650–1655.

Annual hospital volume and colorectal cancer survival in a population-based nationwide cohort study in Finland

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Author: Sarjanoja, Elise1,2; Klintrup, Kai1; Ohtonen, Pasi1;
Organizations: 1Surgery Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
2Department of Surgery, Mehiläinen Länsi-Pohja, Länsi-Pohja Central Hospital, Kemi, Finland
3Upper Gastointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2022-09-08


Purpose: To examine the annual hospital volume of surgery in relation to survival in colorectal cancer. Previous studies on hospital volume and survival following colorectal cancer surgery are conflicting.

Methods: All 49 032 patients who underwent resection for colorectal cancer in 1987–2016 in Finland were included, with complete follow-up until December 31, 2019. Primary outcome was 5-year mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) for quartiles of annual hospital volume for colorectal surgery, adjusted for calendar period, age, sex, comorbidity, stage, tumor location and oncological therapy. Additionally, colon and rectal cancer surgery were assessed separately. Sensitivity analysis of patients with confirmed curative intent was conducted.

Results: Compared to highest quartile (≥108 resections annually), lowest hospital volume (≤37 resections annually) was associated with slightly increased 5-year all-cause mortality (adjusted HR 1.07, 95% CI 1.02–1.12). A pre-planned subgroup-analysis suggested a slightly improved 5-year survival in high-volume institutions for rectal cancer, but not colon cancer surgery. Sensitivity analysis including only those operated with confirmed curative intent suggested no differences between hospital volume groups in colorectal, colon or rectal cancer for 5-year all-cause mortality.

Conclusions: Higher hospital volume is associated with slightly improved all-cause 5-year mortality in colorectal cancer surgery, but this effect may be limited to rectal cancer surgery only. Volume-outcome relationship in rectal cancer surgery should be investigated further using large datasets. These results do not support centralization of colon cancer surgery based on hospital volume only.

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Series: European journal of surgical oncology
ISSN: 0748-7983
ISSN-E: 1532-2157
ISSN-L: 0748-7983
Volume: 48
Issue: 7
Pages: 1650 - 1655
DOI: 10.1016/j.ejso.2022.02.017
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3126 Surgery, anesthesiology, intensive care, radiology
Dataset Reference: Supplementary data to this article can be found online at
Copyright information: © 2022 The Authors. This is an open access article under the CC BY license (